International evaluation of an artificial intelligence-powered electrocardiogram model detecting acute coronary occlusion myocardial infarction.

Autor:	Herman R; Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy.; Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium.; Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia., Meyers HP; Department of Emergency Medicine, Carolinas Medical Center, Charlotte, NC, USA., Smith SW; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA.; Department of Emergency Medicine, Hennepin Healthcare, Minneapolis, MN, USA., Bertolone DT; Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy.; Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium., Leone A; Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy.; Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium., Bermpeis K; Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy.; Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium., Viscusi MM; Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy.; Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium., Belmonte M; Department of Advanced Biomedical Sciences, University of Naples Federico II, C.so Umberto I, 40, 80138 Naples, Italy.; Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium., Demolder A; Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia., Boza V; Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia.; Faculty of Mathematics, Physics and Informatics, Comenius University in Bratislava, Bratislava, Slovakia., Vavrik B; Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia., Kresnakova V; Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia.; Department of Cybernetics and Artificial Intelligence, Technical University of Kosice, Kosice, Slovakia., Iring A; Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia., Martonak M; Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia., Bahyl J; Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia., Kisova T; Powerful Medical, Bratislavska 81/37, 931 01 Samorin, Slovakia.; Faculty of Medicine and Dentistry, Barts and The London School of Medicine and Dentistry, London, UK., Schelfaut D; Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium., Vanderheyden M; Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium., Perl L; Department of Cardiology, Rabin Medical Center, Petah Tikvah, Israel., Aslanger EK; Department of Cardiology, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey., Hatala R; Department of Arrhythmia and Pacing, National Institute of Cardiovascular Diseases, Bratislava, Slovakia., Wojakowski W; Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland., Bartunek J; Cardiovascular Centre Aalst, OLV Hospital, Moorselbaan 164, Aalst 9300, Belgium., Barbato E; Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
Jazyk:	angličtina
Zdroj:	European heart journal. Digital health [Eur Heart J Digit Health] 2023 Nov 28; Vol. 5 (2), pp. 123-133. Date of Electronic Publication: 2023 Nov 28 (Print Publication: 2024).
DOI:	10.1093/ehjdh/ztad074
Abstrakt:	Aims: A majority of acute coronary syndromes (ACS) present without typical ST elevation. One-third of non-ST-elevation myocardial infarction (NSTEMI) patients have an acutely occluded culprit coronary artery [occlusion myocardial infarction (OMI)], leading to poor outcomes due to delayed identification and invasive management. In this study, we sought to develop a versatile artificial intelligence (AI) model detecting acute OMI on single-standard 12-lead electrocardiograms (ECGs) and compare its performance with existing state-of-the-art diagnostic criteria. Methods and Results: An AI model was developed using 18 616 ECGs from 10 543 patients with suspected ACS from an international database with clinically validated outcomes. The model was evaluated in an international cohort and compared with STEMI criteria and ECG experts in detecting OMI. The primary outcome of OMI was an acutely occluded or flow-limiting culprit artery requiring emergent revascularization. In the overall test set of 3254 ECGs from 2222 patients (age 62 ± 14 years, 67% males, 21.6% OMI), the AI model achieved an area under the curve of 0.938 [95% confidence interval (CI): 0.924-0.951] in identifying the primary OMI outcome, with superior performance [accuracy 90.9% (95% CI: 89.7-92.0), sensitivity 80.6% (95% CI: 76.8-84.0), and specificity 93.7 (95% CI: 92.6-94.8)] compared with STEMI criteria [accuracy 83.6% (95% CI: 82.1-85.1), sensitivity 32.5% (95% CI: 28.4-36.6), and specificity 97.7% (95% CI: 97.0-98.3)] and with similar performance compared with ECG experts [accuracy 90.8% (95% CI: 89.5-91.9), sensitivity 73.0% (95% CI: 68.7-77.0), and specificity 95.7% (95% CI: 94.7-96.6)]. Conclusion: The present novel ECG AI model demonstrates superior accuracy to detect acute OMI when compared with STEMI criteria. This suggests its potential to improve ACS triage, ensuring appropriate and timely referral for immediate revascularization. Competing Interests: Conflict of interest: R.H. is the co-founder and Chief Medical Officer of Powerful Medical; M.M., J.B., A.I., B.V., V.B., V.K., and A.D. are employees and shareholders of Powerful Medical. S.W.S., H.P.M., and L.P. are shareholders in Powerful Medical. (© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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